~ My Romanian Journey at Hospice Casa Sperantei

It is just impossible to believe my time at Hospice Casa Sperentei is coming to an end. How can it be ending when it seems I have just arrived and there is still so much work to be done? It has been so rewarding to work with nurses who are so eager to learn and grow professionally. I have said previously and it bears repeating that I am humbled and honored to be surrounded by health care professionals that do so much for patients with so little and do it with an enthusiasm and dedication that makes me believe anything is possible. There is no doubt that the health care system in Romania needs much improvement. Many Romanians do not have access to health care and I have witnessed too many patients that have been unable to receive care due to their lack of insurance or the lack of money to “pay off” the doctors and nurses in order to receive care. As a health care professional this has been incredibly difficult to accept. Although I was quick to judge I learned that most health care professionals need this “dirty money” just to survive in this country. So there is no easy answer as all of the social and health issues are interconnected and complicated. But I smiled with pride every time I witnessed hospice staff I was working with turning down the “dirty money”. Slowly but surely hospice will change the face of what quality health care should look like in this country.
The new inpatient building will be complete in December but the opening delayed until they can raise more funds needed to open the doors. When it is said that one person can’t make a difference, I say oh yes one person can!! I will be reminded of the president of Casa Sperentei, Graham Perolls, who twenty years ago watched helplessly as a young man died in front of him while he was visiting Romania from his native UK. It was this experience that started his journey to improving end of life in Romania. I will watch with excitement as opening day nears and the patients in Bucuresti that need end of life care will have it available.
I am proud of the work that I have accomplished in improving the education and skill of the nurses (and doctors, which still warms my heart at their eagerness to learn from me as well)
here but if truth be told my Romanian colleagues have taught me more than I could have ever taught them. I am thankful for their collegiality and friendship and making sure I knew how much they appreciated me. I have never been more proud to be a GSK employee and return with a renewed sense of pride having seen first hand of the great work our company does to help patients everywhere in the world do more, feel better, and live longer.
In closing…this I know for sure. That my hand in a patient’s hand and a warm smile convey caring despite a language barrier and that my life has been enriched by the Romanian people I have served and the Romanian colleagues I have served with.
Sanatate (wishing you good health)
Holly<a

This past Saturday, hospice held it’s annual Edelweiss Ball which is a major fundraiser for the program. Last year the ball raised 130k euros. The theme this year was a fairy tale one named Once Upon A Time with 250 people in attendance. It included a silent and live auction. The excitement was palpable in the room as the final and highest bid brought in 15k euros (20,000 USD).

All of the services provided by this hospice are free of charge. In Bucuresti the number of patients cared for grew from 449 in 2011 to 764 in 2012. This is a testament to the work by hospice to raise awareness of hospice care and the growing acceptance of the philosophy by the Romanian people. The new building is almost complete but unfortunately hospice is lacking the nine months operating expenses required to open the doors. This means the inpatient end of life care that is desperately needed in this city will not be available for another 9-12 months. But patients will continue to benefit from home care services until the new facility is operational.

As I head into the final six weeks of this journey, I think of all the work that remains and am thankful for what I have been able to accomplish. What an incredible opportunity as a health care provider to contribute to improving end of life care for the Romanian people!

I have come to learn that you experience emotions and events that you did not anticipate when you are on an assignment and away from home. For me, this was completing my doctorate in nursing “officially” here in Romania and I looked around and had no family or friends to celebrate with. Those who supported me and held me up when I thought I cannot do this one more minute were no where to be found to see that I made it. But then I thought I have a Romanian family so I should celebrate with them, and celebrate we did! And the reality is they are just as proud of me as my family and friends back home. So the good news is I will celebrate this milestone event twice. And when I return home, another celebration to be had!

It has become more apparent with my time here in Romania that there is little that separates us from each other. Last week we had a team building day at the site of what will ultimately be the children’s place. It is a donated site that needs much renovation but the area to house the campers is ready and the first group of children who have lost a loved went off for a week of fun and healing. Eventually the inpatient children’s hospice unit will be housed on this property. It is the most serene location out in the country. And yes, lots of Romanian food. No hamburgers and hot dogs at this outing.
Then off to one of my nursing colleagues homes out in the country for a day. Will be a day that stays with me forever. We ate for hours and everything made came from the land. The gardens are unbelievable. Everyone in the country lives off the land mostly out of necessity but what a healthy necessity. We walked through the country eating fruits off the trees, felt like a kid. Life is good and healthy in Romania!

Play time at team building day.

Off to camp

Food and fellowship, on the left two nuns from Ireland doing mission work in Bucharest.

Where to start??? The apartment finding was without a doubt challenging. You arrive in a new city, can’t speak the language, and have no clue where you are or where you need to be in relation to where you are going. But with the help of some “friends” I was able to locate one within walking distance to the hospice. But it seems my jetlag did not allow me to realize that it had nothing other than the furniture in it. For those who can’t figure out why that is a problem it means, no way to cook anything and no bedding/linen. Also, no cable or internet which required me to purchase a year’s worth of service for a 6 month stay. At some point you can’t fight the system (and if you can’t speak the language you are fighting a losing battle anyway) and just hand over the money. Once I moved in the fun really started! A torrential rain revealed the balcony area (where you dry your clothes) leaks and the rain was coming in as fast as it was coming down. And then the shower didn’t drain, and then the washing machine leaked, and then the toilet leaked. And then there was no hot water for 8 days. You get the idea. But, I love my apartment (yes, could do without all the problems) but the tram stops right outside my door and now that I know how to get it around it is awesome. The piazza (produce) market is down the street and I have had the best fruits and vegetables imaginable. Unfortunately, the fresh bread is in there too and there is a strong current that pulls me that way when I enter. For the record, Romanians are the largest consumer of bread in Europe so the saying applies, when in Romania eat like the Romanians!

1. A hospital with no air conditioning in a city where the summer heat exceeds 90 degrees.
2. One nurse for 36 pediatric oncology patients (the norm in the US is 1 nurse for 6 patients).
3. Not having certain common cancer medications available (nystatin is not available in Romania) and the only way patients receive certain meds is through hospice that receives them as donations from the UK.
4. That when hospice runs out of meds there is just not any more until they receive a donation and patients have to do without.
5. That the only way you receive care in the hospital from a physician or nurse is with a bribe. This is a long story and has to do with the low salaries and not being able to survive on salary alone so the bribes are needed to live. Hospice workers do not accept bribes.
6. That mothers have to sleep in a small bed with their sick child in the hospital and no food is provided to them despite their round the clock presence.
7. That several hospice workers do not have cars (unaffordable for many) and take buses or trams to patient’s homes.
8. That many do not have bathrooms and their toilet is a hole in the ground outside. This also means no sink to bathe or for healthcare providers to wash hands.
And with such joy I say can you imagine???
1. Physicians who say to me to teach them, they want to learn from me.
2. Nurses who work very hard for little salary (the best nurses salary is $450 per month and for comparison my rent is 550 per month) and do so smiling and without complaints.
3. That this program, even with its limitations, makes a huge difference in the lives of patients it serves.
4. How humbled I am to work with such an amazing group of people who accept that change is slow and hard to come by but never give up!

Have you ever been guilty of being impatient when a non-English speaking person is asking for help or a visitor needs directions? Have you said if you are going to live in this country you should learn the language? I am that person now on the other side of the fence that we may have been impatient with or judged. I can’t speak the language nor do I know where anything is or how most things work. I have to ask for help for almost everything. It is frustrating not to be able to communicate although it is amazing what sign language can accomplish. I would like to speak the language but it is not easy and does not happen quickly especially with an aging memory. Going to the grocery store is a chore right now as I try to learn the Romanian equivalent of what I am looking for. It takes me twice as long to calculate costs as I had to convert the bananas from kilos to pounds and then calculate the lei to the dollar. I have a new appreciation when people want to speak their native tongue when they are together rather than English because they are in the US and I think they should be speaking English. My perspective has been enhanced now that I am on the other side and this brings newfound patience and tolerance. I encourage you to consider your perspective as you never know when you too might find yourself on the other side of the fence.

Mu Pulse colleague, Julia and I attended a ceremonial tree raising ceremony this week at the construction site of the new inpatient hospice building. This is a custom that raises a pine tree to the roof crowning the structure with good luck and thanks for no construction accidents. An Austrian company has donated the building materials and Habitat for Humanity has donated the labor. Habitat builds small, single level wood framed houses so for them to take on a 4 story concrete building signifies their commitment to improving hospice care in the region. The estimate is that Bucharest should have 230 hospice beds and there are currently 6 which means that less than 6% of the Romanian people that need care receive it. It was shocking to learn that there is a waiting list for hospice care. This is quite paradoxical since hospice patients are terminal and don’t have time on their side. This new facility will add 30 additional beds. Not nearly what is needed but progress is slow in developing countries. Despite our shortcomings in the US healthcare system, we are incredibly fortunate. But every person regardless of where they live in the world deserves quality end of life care…so there is much work to be done.

So lets just suffice it to say that adjusting to life in a new country is no easy feat. Fortunately, most younger Romanianians speak English so that has helped tremendously. The apartment hunting warrants a blog all it’s own and I need time to recover…stay tuned for that blog. Most of the necessary chores are challenging. Tried to switch my phone to a Romanian service and it requires a year contract. Well that doesn’t work so had to buy a cheap phone to use in Romania and will keep my iPhone for my email and the apps that are turning out to be very helpful. Asked for directions yesterday and the person pointed and said 500 meters. No clue how far that was but logged in 4 miles walking yesterday so I just said what’s another 500 meters. I am hoping the walking will help with losing weight but there is a patisserie on every other block (yummy bakery) and the freshly made pastries are staring at me in the window:) and the locals are lined up in the morning at them so there must be something good in there.
Romania is a big city of 2 million and in some disrepair. You definitely don’t want to text and walk as you stand a good chance of ending up on the ground. The people are helpful but not the smiling southern hospitality I am use to. The park was filled with people enjoying the sun and kids playing. The reality is that no matter where we are from, we are more alike than we are different.
Peace,
Holly